By Olivia Loeffler, network director, Medical Staff Services and credentials verification officer
Healthcare has always been demanding, but today’s physicians and APPs are practicing in an environment of increasing complexity. Heavy workloads, administrative requirements, staffing challenges, evolving technology and the responsibility of making high-stakes clinical decisions can place tremendous pressure on clinicians and the entire healthcare team.
Stress and disagreement are inevitable. Unprofessional behavior doesn’t have to be. Why does this matter? Because professionalism is more than courtesy. It’s an important component of a culture of safety.
The Joint Commission recognizes that intimidating and disruptive behaviors can interfere with teamwork, communication and collaboration, and can contribute to medical errors and preventable adverse outcomes. Its current Culture of Safety National Performance Goal emphasizes open communication, accountability, leadership involvement and a code of conduct that defines and addresses unacceptable behavior, including intimidating behavior.
What does unprofessional behavior look like?
Unprofessional behavior is not limited to yelling or obvious confrontation. It can include verbal outbursts, condescending language or tone, dismissive responses, intimidation, reluctance to answer reasonable questions or repeated behavior that interferes with effective teamwork.
There’s also an important distinction: respectful disagreement isn’t disruptive behavior.
The American Medical Association Code of Medical Ethics specifically distinguishes disruptive behavior from criticism offered in good faith to improve patient care. Clinicians should be able to question a decision, challenge a process, advocate for a patient and express a differing clinical opinion without those actions automatically being characterized as disruptive.
The key is how we communicate when we disagree. A clinician can:
- Be direct without being demeaning
- Question a decision without intimidating others.
- Advocate strongly for a patient while maintaining respect for the healthcare team.
Why speaking up matters
One of the greatest risks associated with intimidating behavior isn’t necessarily the interaction itself. It’s what may happen afterward.
When members of the healthcare team become uncomfortable asking a question, clarifying an order or raising a potential safety concern, communication can break down. The Joint Commission identifies open communication and accountability as essential elements of a strong safety culture.
This is why psychological safety and patient safety are closely connected. Physicians and APPs have tremendous influence on the clinical environment. A simple response such as, “Thank you for bringing this to my attention,” can reinforce that speaking up is welcomed, even when the concern ultimately proves unfounded.
Addressing concerns early
When professionalism concerns arise, the objective should not automatically be punishment.
The American Medical Association recommends clear processes for receiving and reviewing behavioral concerns, allowing physicians an opportunity to respond, monitoring for improvement and using corrective actions that are proportionate to the behavior. Its ethical guidance also recognizes that an isolated incident may be different from a pattern of behavior.
Early conversations, when appropriate, can provide an opportunity for awareness, reflection and improvement before concerns become patterns. At the same time, fairness works both ways. Behavioral concerns should be evaluated objectively, and clinicians should have appropriate opportunities to understand and respond to concerns raised about them.
Take a PAUSE
In difficult moments, consider a quick PAUSE:
- P: Pause before responding. A few seconds can change the direction of an interaction.
- A: Address the issue, not the individual. Focus on the clinical concern, process or decision.
- U: Understand the other perspective. Ask questions before making assumptions.
- S: Speak with respect. Tone matters, particularly during stressful situations.
- E: Escalate appropriately when needed. Patient safety concerns should always be raised through the appropriate channels.
Professionalism is a shared commitment
Professionalism does not mean avoiding difficult conversations. Medicine requires difficult conversations. It means creating an environment where physicians, APPs, nurses and other members of the healthcare team can communicate openly, respectfully and confidently in the interest of our patients.
Clinician well-being must also remain part of the conversation. The American Medical Association recognizes physician health and wellness as important to the safety and effectiveness of medical care, and encourages physicians and healthcare organizations to support their well-being.
Recognizing the pressures clinicians experience and maintaining expectations for professional behavior aren’t competing objectives. We can support our physicians and APPs while also supporting accountability, respect and a culture of safety.
A culture of respect and safety
Professionalism isn’t the absence of disagreement. It’s our ability to question, advocate, disagree and communicate while maintaining respect and protecting a culture where everyone feels safe to speak up for our patients.